Side effects

Side effects of prazepam are less profound than with other benzodiazepines.[7] Excessive drowsiness and with longer term use drug dependence are the most common side effects of prazepam.[8][9] Side effects such as fatigue or "feeling spacey" can also occur but less commonly than with other benzodiazepines. Other side effects include feebleness, clumsiness, lethargic, clouded thinking and mentally slowness.[10][11][12]

Benzodiazepines can induce serious problems of addiction which is one of the main reasons for their use being restricted to short term use. A survey in Senegal found that the majority of doctors believed that their training in this area was generally poor. Recommendations for national authorities to take urgent action regarding the rational use of benzodiazepines.[17] Another study in Dakar found that almost one fifth of doctors ignored prescribing guidelines regarding short term use of benzodiazepines and almost three quarters of doctors regarded their training and knowledge of benzodiazepines to be inadequate. More training regarding benzodiazepines has been recommended for doctors.[18]

Contraindications and special caution

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbidpsychiatric disorders.[19]

Mechanism of action

Prazepam exerts its therapeutic effects primarily via modulating the benzodiazepine receptor which in turn enhances GABA function in the brain.[20] Prazepam like other benzodiazepines has anticonvulsant properties but its anticonvulsant properties are not as potent as other benzodiazepines when tested in animal studies.[21][22][23][24]

Pharmacokinetics

Prazepam is metabolised into descyclopropylmethylprazepam (also known as desmethyldiazepam) and 3-hydroxyprazepam which is further metabolised into oxazepam.[25][26][27][28][29] Prazepam is a prodrug for descyclopropylmethylprazepam/desmethyldiazepam (also known as norprazepam or nordiazepam) which is responsible for most of the therapeutic activity of prazepam rather than prazepam itself.[13][20][30][31]

Interactions

Prazepam may interact with cimetidine.[32]Alcohol in combination with prazepam increases the adverse effects, particularly performance impairing side effects and drowsiness.[33]